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My answer is based on this being your situation: Ages ago when 1st dealing w LTC (aka facility based) Medicaid for my handful of a MIL in Louisiana, it was easy peasy & caseworker super helpful. We got a short list of documents needed from NH admissions & MIL went in as “Medicaid Pending”. Abt week later caseworker gave hubs application & stack of financial documents back and said get her to under $2k then contact me. He wasn’t even going to start to input anything as MIL had too much $; so “spend it out then call me”. Then after she moved to TX, it was oh so much more complex. By the time I had to deal w my moms TX LTC Medicaid application, I kinda knew how financial & legal documentation heavy it would be. For both MIL & mom for TX, the NH gave us a list of documents (ea NH puts their list together, moms was 1 page, MIL was 2 as just lots more in minute detail) that needed to accompany State LTC application AND for both, it was the admissions person at ea NH who reviewed all documents first AND only if in their initial review they felt all was good to go did they submit entire packet along with their NH bill to caseworker assigned to the facility & accept them as “Medicaid Pending”. This was the system for TX for when we were dealing with the moms; other states may not do it like this. My mom was good on her financial stuff as far as NH concerned but MIL wasn’t as she had written checks out regularly to an aide to get her liquor & it looked like “gifting”. Took forever for BIL to get it resolved.
So imho if it’s NH staff who is telling you there's a financial problem then ime they detect something amiss w her finances & based on their experience, feel she will not qualify. I’d suggest that you Review whatever submitted & look at $ in detail. If she sold her home or a car w in past 5 years the entire amt from Act of Sale to her better have been deposited & to the penny. If theres anything that deviates big time from her regular pattern of income & spending, that tends to be a red flag for eligibility. Anything obvious???
So what is NH suggesting?.... they take her “pending” & she does the standard copay of her mo income but u sign off a financial responsibility contract? or private pay up front w contract? or they want her out?
There also is medical “at need” requirements for LTC Medicaid. She has to show need for skilled nursing care if she wants to be in a NH. Most go into a NH as rehab patient from a hospitalization so they come in w MediCARE paying for rehab & have a fat chart that clearly shows “need”. Then they cannot return home so segueway to LTC resident & file for LTC Medicaid to pay.
BUT
If your mom entered from being at home or IL or even in AL, that fat chart may not be there. So at a glance, she doesn’t appear to “need” skilled care. I had medical eligibility issues w my mom as she moved from IL into NH. I - as POA - filed medical appeal but nursing staff did follow thru on all health care documentation needed. It was that some RXs, labs & dx’s from her MD were left off. Medical eligibility is a whole different path to resolve & NH ime takes the lead.
anything else that could be an issue.... citizenship? her needs are more than this NH is set up for? any psych issues?
somewhere there r clues as to what the problem is.....
Medicaid has a cap for monthly income, my State its a little over 2300. If you LO is over the State cap, some States allow a Miller trust where the overage gets deposited to the Trust.
The house and a car are exempt assets if under the cap allowed. So you need to look at insurance policies that have cash value. Any type of savings. (employer policies don't count) Some savings are exempt. Those not exempt need to be used to pay for LOs care.
With me, Mom was under the monthly cap, she had enough money to pay 2 months care. I applied for Medicaid 90days before she needed it. Paying privately spent her down to 2k. I provided all paperwork needed. Verified with Moms caseworker all was done and Medicaid started paying the 3rd month.
If LOs assets and/or monthly income are the problem, then a lawyer, well versed in Medicaid, maybe a good thing. Medicaid allows the cost of a lawyer.
I would be very involved if using someone else to apply. In my State u only have 90days to spenddown, get Medicaid info needed and find a place for the applicant.